Latest articles about Change Management http://www.longwoods.com http://blogs.law.harvard.edu/tech/rss Mon, 17 Nov 2008 13:03:42 -0500 Mon, 17 Nov 2008 13:00:45 -0500 FeedForAll v2.0 (2.0.2.9) http://www.feedforall.com Healthcare organizations offer a promising but complicated work environment for health services researchers. Working directly within these organizations can yield stronger connections with decision-makers, better access to organizational data and, ultimately, greater potential for research findings to influence decisions. However, there are also challenges for the researcher and the host organization related to divergent work objectives, mismatched timelines and unclear criteria for performance assessment. The authors examine the advantages and disadvantages of this research model for both the health services researcher and the decision-maker. http://www.longwoods.com/product.php?productid=20266&cat=572&page=1 FF814535-241F-4EC9-B33E-D2B11B1371CC Mon, 17 Nov 2008 13:00:45 -0500 This article reports on the transfer of perinatal services at St. Joseph's Health Care, in London, Ontario, to London Health Sciences Centre (LHSC). The transfer of perinatal programs, services and people/providers to LHSC generates concern in key stakeholders with respect to a potential negative impact on the quality of care delivery, staff work life and morale, team performance, recruitment, retention and other performance indicators. Our main task was to establish "readiness and capacity for the change" in the years leading up to the actual transfer, with a strong focus on attending to the human side of the change, clinical and cultural alignment. We describe the external and internal challenges of the transfer and the approach that we took in building readiness, and end with 10 lessons learned and applied throughout the change process. http://www.longwoods.com/product.php?productid=20090&cat=563&page=1 D589B00A-7E00-4416-8A19-5E60E1C7F5F8 Sat, 15 Jul 2006 14:57:01 -0400 Wait times and the wait times agenda are on the Canadian schedule. Although most Canadians support our healthcare system, they are concerned about access. Resolving the wait times agenda might help increase Canadian confidence in the system's ability to provide timely access to care. While the paper by Trypuc, MacLeod and Hudson demonstrates well how quickly governments can mobilize tools and resources to address pressing policy needs, it also reveals the limited and narrow approach taken by governments to the wait times agenda. The Ontario government should recognize that a more integrated and comprehensive approach can significantly advance the wait times agenda and make the system more accountable. Only a broad-based approach will ultimately succeed in reducing wait times and building a sustainable system. A shift in values needs to take place away from the current emphasis on acute care and toward an inclusive vision of home- and community-based care that puts more emphasis on disease management, chronic care and independent living, if there is ever to be any real progress in the battle. Governments will ultimately be held accountable by Canadian healthcare consumers if they fail to make this important shift. http://www.longwoods.com/product.php?productid=18319&cat=448 B6113D02-D3FD-46F6-B441-5659C769C38C Sat, 15 Jul 2006 14:56:43 -0400 The paper by Trypuc, MacLeod and Hudson provides a timely and important overview of methods to sustain provincial wait time strategies. The emphasis on accountability for patient access to timely care throughout the healthcare system comes through strongly - as it should. These accountabilities are made "real" through purchase service agreements. Physician-hospital relationships are a fundamental aspect of this accountability. This commentary suggests the inclusion of two additional supporting tools in addition to those cited by the authors of the lead paper - quality monitoring and the use of industrial engineering techniques for queue management and patient flow analysis. Strong and persistent leadership of patient access strategies will ensure sustainable change. http://www.longwoods.com/product.php?productid=18318&cat=448 50F3FAB8-EEE0-441C-8378-AC7F944216F1 Sat, 15 Jul 2006 14:56:18 -0400 Significant early positive cultural changes have been made in the Ontario healthcare system to address the province's Wait Time Strategy. Improving efficiency in parallel with the introduction of accountability agreements will provide early successes. However, there are fundamental system weaknesses that must be addressed in the long term to sustain the program. These include a wait list information system that addresses all patients waiting for care, additional healthcare providers with wider scopes of practice, improving hospital capacity, accountability agreements with agreed-upon performance indicators, new payment systems for physicians and a fundamental change in referral and care processes. Innovative approaches such as gain-sharing should be considered. Though resources are scarce, there is a need for significant early additional investments to achieve long-term success. http://www.longwoods.com/product.php?productid=18317&cat=448 62995FCE-8B84-4305-878D-4B2F658C23CB Sat, 15 Jul 2006 14:55:44 -0400 After a late start, Ontario is well on its way to implementing an ambitious Wait Time Strategy that has already begun to show some tangible improvements in access to the five priority areas. This commentary argues that in addition to the supporting tools identified in the lead essay, a sustainable wait time strategy must encompass prevention and demand management, address shortages in health human resources, provide patients with recourse to a safety valve and promote interprovincial standards and cooperation. Care will also be needed to ensure ongoing support and engagement of organized medicine, realigning incentives to support patient care and extending the reach of health information systems into the community. http://www.longwoods.com/product.php?productid=18316&cat=448 08DBF865-D509-442D-A464-FC7B6CCE4E88 Sat, 15 Jul 2006 14:55:11 -0400 The Ontario Wait Time Strategy is a focused initiative to reduce wait times in five key areas. The plan includes key components of successful change management including targets, funding and driving a culture of accountability. Successfully "redesigning" this slice of the healthcare system will, it is anticipated, act as a catalyst for sustainable change throughout the system. In the mind of this observer "from the trenches," the Wait Time Strategy must quickly be followed by a framework that addresses demand pressures from other parts of the system, but more importantly must be clearly aligned with the overall goals of the system - to improve health outcomes and support healthy lives - across the entire continuum of health services, including prevention, primary, community, long-term and acute care. Accountability for appropriateness and evidence-based care must be as significant as accountability for efficiency and volumes. http://www.longwoods.com/product.php?productid=18315&cat=448 2040F467-75F4-4490-9699-65AE408D094D Sat, 15 Jul 2006 14:54:42 -0400 A robust accountability strategy is at the core of creating a safe, efficient, effective and sustainable system of healthcare. The commitment to be accountable must extend far beyond the providers of care to include every person involved in the funding, administration, delivery and support of patient care (both directly and indirectly). The Alberta Bone and Joint Health Institute has fostered a new system that will measure, analyze and give valuable feedback to all stakeholders in all three essential domains of system accountability: access, quality and cost. The Institute has employed four key strategies to create system accountability in a hip and knee pilot project: collaboration between stakeholders in defining goals and measures that matter to them; the use of "world's best evidence" to drive decisions and to establish goals and benchmarks to measure against; collection of useful data and its analysis to inform improvement decisions; and timely feedback of relevant data in domains of interest to stakeholders on system outputs in the key domains. While these strategies have not yet been proven to be effective in creating the desired "culture of accountability," they are having a significant clinical impact and do have potential to lead to that outcome. http://www.longwoods.com/product.php?productid=18314&cat=448 2306A409-F66B-4802-9647-17E9C9FFD9D8 Sat, 15 Jul 2006 14:53:38 -0400 Wait limits have improved UK healthcare access, and Ontario's Wait Time Strategy bears a remarkable resemblance. There appears to be an implicit assumption that capacity and efficiency factors are the main causes of waits. The improvement mechanism is driven by performance measurement that reports wait time outcomes. Our experience makes us conclude that Ontario's plans contain risks. http://www.longwoods.com/product.php?productid=18312&cat=448 1B2CEA29-0D9D-45F4-9448-D777D785E79A Sat, 15 Jul 2006 14:53:07 -0400 Ontario's Wait Time Strategy - a significant change management initiative - is designed to improve access to healthcare services in the public system by reducing the time that adult Ontarians wait for services in five areas by December 2006 (cancer surgery, cardiac revascularization procedures, cataract surgery, hip and knee total joint replacements, and MRI and CT scans). These five are just the beginning of an ongoing process to improve access to, and reduce wait times for, a broad range of healthcare services beyond 2006. http://www.longwoods.com/product.php?productid=18311&cat=448 CD3DD399-ABC7-41D6-8408-88A1326D6AA2 Sat, 15 Jul 2006 14:52:28 -0400 In the last issue, we asked: What can a small country of only 5.3 million people teach us about health informatics? When it comes to physician office computing and the electronic medical record (EMR), it may be worth taking a closer look at what the Danes have accomplished and how they got there. http://www.longwoods.com/product.php?productid=16151&cat=255 E519F9F4-3DD3-40FE-8D36-6C84704CD68E Thu, 15 May 2003 14:44:53 -0400 The NHS is to be congratulated on its successful initiative to lower ER waits, and there is much that Canadian decision-makers can learn from the experience. By setting clear goals and then funding them, decision-makers at the macro level are validated. Institutionally, ERs benefit from best of breed approaches and learning from successes. http://www.longwoods.com/product.php?productid=18132&cat=439 F6CB496D-E0A0-49A1-B125-5977473E9336 Wed, 15 Mar 2006 14:44:21 -0400 Is there a crisis in healthcare leadership? In order to understand this question we must first look at what is meant by the term leadership. We prize and admire leadership skills, yet we have little understanding of how and why some persons are more effective leaders than others. This paper describes the changing concept of leadership in the context of both corporate and healthcare settings. The approaches taken in corporate leadership development programs are contrasted with the way in which leaders have been developed in healthcare. The authors assert that there are unique characteristics of health systems and organizations that warrant a tailored approach. A new model of developing healthcare leaders is proposed, one that could transform the educational process and improve outcomes. The authors call for a "back to basics" about how adults learn and outline an approach to leadership development in healthcare that includes principles of competency-based development, interdisciplinary and team learning and continuous assessment. Their conclusion is that leadership development is not done solely to improve the leadership skills of one individual but is an essential component of the development of the organization as a whole. Progressive health systems that invest in leadership development for the entire senior management team will have the more significant return on investment in terms of organizational effectiveness. http://www.longwoods.com/product.php?productid=16891&cat=345 C44B7E46-3726-441A-ADE3-3905306CB409 Tue, 15 Jul 2003 14:43:40 -0400 Baycrest Centre is one of the largest Academic Health Centres in Canada serving the aging population. As such, it has very complex information management (IM) requirements. Recently, a research project was carried out to determine the extent to which electronic health record (EHR) technologies are available and implemented within long-term care (LTC) organizations of comparable dimensions. Data collection included Internet searches and telephone interviews with targeted technology vendors and facilities. Results showed that although there are many superficial similarities between LTC and acute care, care delivery models and processes are so different, and the IM and EHR needs so unique, as to require different technology solutions and information management approaches. However, progress in development of relevant LTC solutions has been slow - 70% of vendors have chosen not to participate in LTC applications development. LTC facilities also expressed frustration with the fact that implementing an EHR is an extensive and expensive process, and yet there is minimal evidence to lobby for its implementation. Research to date has shown that benefits cannot be measured on a return-on-investment basis. Empirical data remain limited, and most benefits have historically been of a qualitative nature. Given the lack of evidence and a viable technical solution, it is not surprising that most LTC facilities have struggled to advance in the implementation of EHRs. This article presents a number of challenges to both the vendor and health informatics communities. Without appropriately addressing these challenges, relevant solutions for IM in LTC will fail to meet the well-established and much-discussed demographic of an aging population that is growing exponentially. http://www.longwoods.com/product.php?productid=16170&cat=260 A1B3F1B6-8EEC-4C31-B7D7-461E8E0727E7 Wed, 15 May 2002 14:43:07 -0400 The Newfoundland and Labrador Centre for Health Information was established to make the province's Health System Information Task Force's vision of a quality person-centred health information system a reality. Since 1996, the centre has been working with partners to develop a comprehensive Health Information Network. The centre has obtained government support to build the unique personal identifier/client registry, and is presently finalizing a proposal to government to fund a project for the Newfoundland and Labrador Pharmacy Network. Work also continues at Newfoundland and Labrador Centre for Health Information towards the development and dissemination of quality health information. http://www.longwoods.com/product.php?productid=16163&cat=254 5AFC113B-C577-4104-838A-E44A4B387451 Sat, 15 Dec 2001 14:41:59 -0400 Recent research has shown that hospital restructuring that included staff layoff has adversely affected the role, health and well-being of nurses who remained employed. Further research found that nurses working in environments that reflected resonant (emotionally intelligent) leadership reported the least negative effects to their health and well-being following hospital restructuring. What remained unclear was the mechan-ism by which this mitigation occurred. The purpose of this paper is to explore additional findings from this leadership research and discuss one explanation unique to the academic literature for the mitigation variable - the investment of relational energy by resonant nursing leadership to build relationships with nurses and manage emotion in the workplace. http://www.longwoods.com/product.php?productid=17019&cat=355 E877C977-FF4B-4546-951B-C34EDD18CB4F Tue, 15 Nov 2005 14:41:18 -0400 Denmark and Alberta are both advanced in the application of the Western scientific model of healthcare and both currently enjoy similar levels of economic prosperity. Each has a significant investment in medical care, including the use of acute care hospitals, health provision by scientifically trained medical practitioners and dispensing of pharmaceutical agents. Given these similarities, we felt it would be instructive to evaluate the adoption of the latest wave of medical technology, computerized medical records and associated supporting capabilities. http://www.longwoods.com/product.php?productid=18933&cat=487 8A1FFA3A-9FB7-4327-82DB-9B6934096933 Tue, 15 May 2007 14:40:01 -0400 Stroke is the fourth leading cause of death in Canada. Almost 60% of stroke survivors are left with a moderate to severe impairment or are so severely disabled they need long-term care. In addition to the toll on a person and his or her family and friends, it is estimated that stroke costs the Canadian economy $2.7 billion a year. http://www.longwoods.com/product.php?productid=18407&cat=450 C8F732D3-35D2-4AF3-8AC5-959DE96B494B Fri, 15 Sep 2006 14:39:15 -0400 With the demand for electronic health information systems (EHIS) in Canada on the rise, there is an urgent need for qualified health informaticians to ensure their proper deployment to maximize the intended benefits. In its 2003-2004 business plan, Canada Health Infoway (2004: 2) has estimated that "there will be a need for an additional 1,500-2,000 technology, health informatics and change management personnel over the next six years as Infoway's investments are realized." Similarly, the American Medical Informatics Association (AMIA) has estimated the need to train 10,000 health professionals in applied health informatics by 2010 to lead and facilitate EHIS implementation efforts in the United States (AMIA 2005). One strategy to meet such demand is to increase the supply of health informaticians through expanded formal postsecondary health informatics (HI) education programs. Yet another is to "retool" existing health and information technology (IT) professionals through continuing education to provide them with the necessary HI knowledge and skills. This paper reviews our ongoing efforts to build HI capacity in Canada. First, we revisit the pan-Canadian HI education strategy envisaged through a series of planning initiatives in 2001-2002. Next, we describe a recent effort among four western Canadian universities to establish a distributed Master of Science (MSc) program in HI. Then, we present an overview of a collaborative HI research training program among eight Canadian universities currently under way. Finally, we share the experiences, challenges and next steps ahead. http://www.longwoods.com/product.php?productid=18126 0ECFBDC9-69D8-4889-971D-01210BBD1AA9 Wed, 15 Mar 2006 14:38:33 -0400 Retention of health professionals is a serious problem in northern and rural Canada. Magnet hospital factors are known to increase job satisfaction, which contributes to retention. The purpose of this paper is to examine the extent to which magnet hospital characteristics (management support, nurse-doctor and nurse-manager relationships, professional autonomy and responsibility) contribute to northwestern Canadian hospital nurses' job satisfaction. Participants were 123 nurses from 13 hospitals in western Canada. They completed a survey and structured interview that provided data on their attitudes and perspectives about their hospital jobs. We found that some magnet hospital characteristics apply in northern and rural western Canadian hospitals. Our findings indicate that management support and nurse-manager relations are important to nurses' job satisfaction, but participants' views of management were fairly negative, an issue that management needs to address. Nurses' ability to work professionally and autonomously is also important to their satisfaction. There are indications that nursing supervisory skill sets need to be upgraded in some instances. http://www.longwoods.com/product.php?productid=18379&cat=451 4127912E-7BE1-48D2-9F3D-84DC01A9FEC6 Fri, 15 Sep 2006 14:37:49 -0400 Nursing leaders have traditionally held leading roles in healthcare. For years, nurses have articulated and advocated collaborative and shared visions of care delivery. We have co-created models of care that have emphasized caring and responsiveness to individual and family (customer) needs. We have acted as strategic and operational connectors, individuals who sat at organizational senior tables informing administrative strategic and operational decisions with an understanding of the impact a particular decision might have on an individual's care. Nursing leaders have served as a valued "check and balance," competent professionals schooled in the complex systems of healthcare who could ensure that decisions made by an organization's administrative leadership were at least informed by the reality of the clinical situation. In short, we have been valued organizational leaders. http://www.longwoods.com/product.php?productid=16251&cat=274 0319A0D6-52ED-4A94-A7D0-C8B6A0C71FFF Sat, 15 Nov 2003 14:36:39 -0400 Collaborative partnerships can help improve integration and quality in local healthcare systems. We describe an innovative approach that was implemented following the formation of a tri-provider partnership between homecare and two acute care hospitals. The approach questioned the prevailing thought that the home is always the most appropriate and least costly location to provide services to clients traditionally served by homecare. The goal was to improve the delivery of healthcare by better integrating patient characteristics with services provided by homecare, hospitals and family physicians. The result was the implementation of a pilot project in which both homecare clients and non-urgent hospital patients could be served in a hospital-based ambulatory nursing care clinic. http://www.longwoods.com/product.php?productid=18106 60FE3D42-E380-484F-90DD-00C01A6DDF98 Wed, 15 Mar 2006 14:34:43 -0400 In previous issues, we have been exposed to what the Danes have been able to accomplish with physician office computing and the electronic medical record (EMR). Here is another success story from another small country that has managed to maximize physician use of computers and the use of electronic medical records to improve the health status of its population. http://www.longwoods.com/product.php?productid=16154 60E5A063-886F-40C6-AA5A-8273404359F2 Fri, 15 Aug 2003 14:33:59 -0400 The Registered Nurses Association of Ontario (RNAO) has taken the lead in Canada in the development of best practice guidelines for nurses. The Nursing Best Practice Guidelines (NBPG) Project funded by the Ontario Ministry of Health and Long-Term Care involves development, pilot implementation, evaluation and dissemination of a series of clinical practice guidelines (CPGs) as has been previously described in Hospital Quarterly (Grinspun, Virani and Bajnok 2002). In the early stages of development and pilot implementation of the guidelines, it became apparent that organizations were struggling to identify ways to introduce and implement the guidelines. The majority of the pilot sites were providing education sessions to facilitate CPG utilization with little attention to other implementation strategies. Those charged with introducing the CPG into the clinical setting were soon faced with a myriad of implementation challenges for which they needed solutions. It became clear that a planned, systematic approach to facilitate implementation of CPGs was needed. http://www.longwoods.com/product.php?productid=16515 AC991BF6-525B-4AC2-8FB9-4FA87983D57E Fri, 15 Mar 2002 14:33:12 -0400 This article follows on from part 1 on the history of medical computing in Alberta and Denmark (Protti et al. 2007). It provides background to the driving forces for automation in primary care physician offices in Denmark and Alberta. It also summarizes the functionality of electronic medical records (EMRs) in both jurisdictions and compares the status of primary care physician office computing in Alberta to that of Denmark. The scoring system used is based on data gathered from publicly available sources on the Internet, databases held by the respective jurisdictional programs (MedCom and Physician Office System Program [POSP]) and interviews with individuals involved in the deployment of systems. The article offers a novel method of scoring the adoption of computerized advances in the office setting that may be applicable to other health jurisdictions, at country, state or provincial levels. http://www.longwoods.com/product.php?productid=18936&cat=487 2D7384CC-6390-47AB-9BC1-2BBAAEA1A404 Tue, 15 May 2007 14:31:31 -0400 Commitment to patient safety must be a priority of every healthcare institution. York Central Hospital has implemented a quality initiative to address multi-professional issues that result from a significant sentinel event where there is a notion of perceived wrongdoing due to an adverse and/or unexpected outcome - the Multi-Professional Mortality Review process. Unlike the traditional approach to professional review in healthcare, which results in a culture of error finding and blame-placing, this process acknowledges the fact that human errors can occur, reaffirms what is working well and ensures that steps are taken to mitigate the effects of the sentinel event under consideration. The review panel consists of healthcare professionals who have been involved in the case. The panel reviews the case and makes recommendations to senior clinical committees and hospital administration. The multi-professional review process has been met with a positive response at York Central Hospital and, to date, has served as a driving force behind the implementation of a number of systemic and professional changes. http://www.longwoods.com/product.php?productid=16625 DEF0679E-1C64-4AD1-B232-BE2AD5F53126 Sat, 15 Jun 2002 14:29:56 -0400 This article describes progress being made towards developing a comprehensive and integrated system of cancer control in British Columbia. It includes a description of the role of the BC Cancer Agency, its history, how and why it decided to move in this direction, as well as the reasons for recent changes, further improvements that are needed and some of the lessons that have been learned. http://www.longwoods.com/product.php?productid=16755 41D0237B-16C0-4387-8F4B-B19E973E35C6 Wed, 15 Mar 2000 14:29:00 -0400 This article shares what it was like to participate in the IC 5 Collaborative Project. It presents interviews conducted with a sample of the participants and the coaches to gain a richer understanding of their IC 5 experience. The article discusses key points for organizations to consider before they engage in an improvement collaborative, based on the participants' views of what worked well and challenges they experienced, and suggestions about what they would do differently. http://www.longwoods.com/product.php?productid=18795&cat=481 841F9DD6-A5A3-498E-B18C-CDB902539C3D Sun, 15 Apr 2007 14:28:21 -0400 Looking into a future marked by intense competition for talent, growing numbers of employers are striving to create "workplaces of choice." Yet, despite the consensus that health human resources are a vital piece of the healthcare reform puzzle, few health service organizations have developed comprehensive strategies to address work environment issues. The cumulative impact of years of cost-cutting, downsizing and restructuring have left Canada's healthcare workforce demoralized, overworked and coping with working conditions that diminish both the quality of working life and organizational performance. http://www.longwoods.com/product.php?productid=16509 1AD8B184-1BB8-4A26-9FEF-3F3A5F10A6E1 Sat, 15 Jun 2002 14:27:22 -0400 An essential outcome of professional practice environments is the provision of high-quality, safe nursing care. To mitigate the quality and safety chasm, nursing leadership at St. Michael's Hospital undertook a strategic plan to enhance the nursing professional practice environment. This case study outlines the development of the strategic planning process: the driving forces (platform); key stakeholders (process and players); vision, guiding principles, strategic directions, framework for action and accountability (plan); lessons learned (pearls); and next steps to moving forward the vision, strategic directions and accountability mechanisms (passion and perseverance). http://www.longwoods.com/product.php?productid=18171 8C8A49D7-9061-4970-BE0E-088E47CB87B1 Mon, 15 May 2006 14:26:47 -0400 As we plan to increase our spending on health information technology in Canada, this article cautions that we must manage risk carefully and get the most out of our investments. The author outlines 13 principles for investments in information infrastructure that were derived from observations of successes and failures in health and other industries.These principles are: be certain funding is adequate; communicate project objectives in clinical or business terms; actively manage stakeholder expectations; where possible, fund results, not technology; learn from the successes and failures of others; plan for failure; put users in the driver's seat; invest in success; build teams with experience; maintain strong communication links with stakeholders; include process design in every project; keep projects short; and avoid creating political footballs. http://www.longwoods.com/product.php?productid=16161 EA3A8F4F-D2AA-4032-8F59-BE2EA1B26346 Sat, 15 Dec 2001 14:26:14 -0400 Over the past few years, there has been a steady stream of visitors to Canada from the US Veterans Health Administration (VA). Led by the former Under Secretary for Health in the Department of Veterans Affairs, Dr. Ken Kizer, they come to tell the remarkable story of how the VA transformed itself from a hospital-based bureaucracy described as "dangerous, dirty and scandal- ridden" to a healthcare system for veterans recognized for its high-quality, patient-centred care. It is a fascinating story of how a publicly funded healthcare service changed its entire approach to patient care with a quality improvement lens at its core. Fifteen years ago, critics of the VA called for its complete privatization as the only solution to fixing its problems. A team of quality champions set out to prove otherwise. Canada has some lessons to learn. The VA is a compelling role model for Canadian reformers, in large measure, due to its public sector character. http://www.longwoods.com/product.php?productid=17388 11085031-485D-4EF9-A562-126463FF926B Sun, 15 May 2005 14:25:34 -0400 Participants in the Cochrane Collaboration conduct and periodically update systematic reviews that address the question, "What works?" for healthcare interventions. The Cochrane Library makes available quality-appraised systematic reviews that address this question. No coordinated effort has been undertaken to conduct and periodically update systematic reviews that address the other types of questions asked by healthcare managers and policy makers, to adapt existing reviews to highlight decision-relevant information (including the factors that may affect assessments of a review's local applicability) or to facilitate their retrieval through a "one-stop shopping" portal. Researchers interested in evaluating new methodological developments, health services and policy researchers interested in conducting and adapting systematic reviews, and research funders all have a role to play in making systematic reviews more useful for healthcare managers and policy makers. http://www.longwoods.com/product.php?productid=17872 AE8D554C-C0F3-415D-BB47-FB41E4ECC3E8 Sun, 15 Jan 2006 14:23:19 -0400 Competency models, a combination of identified skills, knowledge and attributes required for successful role performance, lend a roadmap for success to leaders of today and the new leaders of tomorrow. In healthcare, where the environment is ever-changing, and the pool of qualified leaders is limited and shrinking, competency models help to identify required areas of strength for success in performance. http://www.longwoods.com/product.php?productid=16667 712BFD12-4BE0-400C-BD2D-F220B706B5F7 Sun, 15 Dec 2002 14:20:11 -0400 This thoughtful essay conveys a logically ordered series of concepts that may help develop a process to more fully integra te evidence into healthcare management decisions. In responding to this article we have tried to think bro adly about what might be discovered if t he ideas of Browman, Snider and Ellis were put into practice. We have chosen to focus on factors that could confound the five-point plan suggested by the authors. Browman, Snider and Ellis provide an interesting overview and advocacy for evidence - based medicine and its application. The authors recognize that the area under investigation, oncology, may lend itself more readily than others to the facilitation of evidence - based practice. They introduce the concept of healthcare as a negotiating environment and the healthcare manager as a potential catalyst for change. http://www.longwoods.com/product.php?productid=17142&cat=342 2EDDB17A-3773-43FB-AA13-52C692886194 Wed, 15 Jan 2003 14:19:00 -0400 Pink et al. discuss some of the issues related to pay-for-performance for individual and organizational healthcare providers. This commentary addresses key success factors for the implementation of individual pay-for-performance in publicly financed Canadian healthcare organizations. Publicly financed healthcare organizations in Canada have been relatively slow to adopt performance-pay programs as compared with private sector organizations; and those that have been developed have been, for the most part, rather crude. In many cases, they have become an additional mechanism for delivering base pay, rather than a true variable-pay program that motivates and differentiates performance. In light of the many issues that need to be addressed, we feel that pay-for-performance should be introduced gradually, beginning at the most senior levels of the organization. Above all, it is critical for publicly financed healthcare organizations to recognize that introducing pay-for-performance involves not only a set of structures and processes, but also likely a profound change in organizational values and behaviours. http://www.longwoods.com/product.php?productid=18266&cat=447 31011D15-A621-4C92-8781-94EA1EBDC50F Mon, 15 May 2006 14:18:23 -0400 [No abstract available for this article.] http://www.longwoods.com/product.php?productid=16213&cat=261 65682E95-E135-49DA-9503-2CDF6C76B397 Tue, 15 Oct 2002 14:16:56 -0400 Communication, in all its myriad forms, has enormous implications for healthcare organizations, particularly during these times of unprecedented and accelerated change. If left ignored or given lip service, it can lead to organizational paralysis, resistance to change and a demotivated workforce. When championed and elevated to a status of strategic importance, it can do just the opposite: promote change through understanding; inspire employees, physicians and volunteers; win the support and influence of vital stakeholders; and achieve corporate goals. Both directly and indirectly, the successful application of communication helps us to achieve our common goal as caregivers: provide excellence and quality in patient care, in teaching and in research. http://www.longwoods.com/product.php?productid=16546 9ADE006F-4199-4BA7-9284-99BFB3DD7802 Mon, 15 Mar 1999 14:15:45 -0400 The evidence on evidence is conclusive. Incorporating evidence in decision-making processes can improve decision-making outcomes (Davies and Nutley 1999), but few healthcare systems have embraced the use of evidence to the extent needed to achieve the potential benefits. Throughout the world, health systems have "not delivered the desired health outcomes that are possible with current professional knowledge " (Ibrahim and Majoor 2002) . Browman, Snider and Ellis have suggested that there has been a lack of systems - level uptake of evidence-based healthcare: While systems may have access to the evidence, existing structures and processes have not facilitated effective transfer to operations. http://www.longwoods.com/product.php?productid=17140&cat=342 E59C8E36-7C17-4497-B043-A8E5D5B402C3 Wed, 15 Jan 2003 14:14:47 -0400 The Executive Training for Research Application (EXTRA) is a new training program that aims to increase the skills of health services executives and their organizations to use research evidence in healthcare management and decision-making. This paper describes the goals and rationale of the EXTRA program and its learning objectives and curriculum, and reports on some early baseline evaluative research. In particular, the authors address the opportunities that EXTRA offers to leaders in the nursing profession to transform the practice of nursing and patient care, and the unique opportunities that the program offers for collaboration across the healthcare professions and disciplines. While the EXTRA training program requires substantive investment of time and commitment by healthcare leaders and their organizations, it offers great potential for increasing research application in healthcare leadership decision-making. It is therefore a potential long-term lever of cultural decision-making change within healthcare organizations. http://www.longwoods.com/product.php?productid=17617 37288E0B-3BC8-4CA6-8332-26E75D25C0DF Thu, 15 Sep 2005 14:13:51 -0400 England is the world leader in moving the health information agenda forward at a national level. Many healthcare organizations around the world have more advanced information technology applications, but in terms of a national strategy, plan and commitment, the English are second to none. We can learn the most from the English in the areas of planning, funding, primary care, the Internet, standards, and electronic records. http://www.longwoods.com/product.php?productid=16206&cat=256 F0C1B5EA-FECE-4340-B0E3-B3958FC1E7F7 Tue, 15 May 2001 14:12:48 -0400 As I reflect upon my role as Vice-President of Patient Programs and Chief Nursing Officer in a large community hospital in Barrie, Ontario, I constantly ask myself whether I am providing effective stewardship in a time of huge transformation. The battlefield in healthcare continues to be scarred with poor decisions. As leaders, we are faced with such major problems as health human resource shortages, excessive management spans of control, unacceptable patient and employee injury rates, exponential growth in chronic diseases spurred by episodic care approaches and technological growth that consumes inordinate amounts of money. Our collective challenges are in shaping and positioning our organizations, and their articulation within healthcare systems, to ensure that we can meet the growing demands for high-quality health services within limited resources. http://www.longwoods.com/product.php?productid=18597&cat=461 5AEE516C-392F-48E2-929A-5F975102C7EB Fri, 15 Dec 2006 14:12:14 -0400 Fall injuries represent a huge healthcare, social and financial burden to the Canadian population. In 2004, the McGill University Health Centre (MUHC) was awarded recognition as a National Spotlight Organization for Implementation of the Registered Nurses Association of Ontario Best Practice Guidelines (BPGs). That same year, the author and co-leader of the Best Practice Guideline Program began the CHSRF Executive Training in Research Application (EXTRA) Program with the goal of reducing falls injuries, one of the most common adverse events in the MUHC and in acute care in Canada. This demonstration project used multiple strategies to strengthen a culture of safety and improve performance relating to adverse events, including: pilot testing several evidence-based falls prevention interventions (autumn 2005), training teams of champions to work across multiple sites, developing an infrastructure to support organizational change, modifying existing quality indicators to become benchmarkable, conducting a cost analysis of falls prevention, evaluating pre- and post-pilot surveys of organizational climate and obtaining initial baseline measures of the safety climate within the organization. Positive patient, practitioner and organizational outcomes suggest that falls safety prevention is feasible in large, complex healthcare organizations - and that safety is both a moral and a financial imperative. Next stages of the BPG program include full rollout, and measuring sustainability via a formal outcome evaluation study. http://www.longwoods.com/product.php?productid=18458&cat=452 DBABB8CB-5892-43FA-B89E-EB0A37AFEC40 Sun, 15 Oct 2006 14:11:24 -0400 We conducted a Functional Organizational Readiness for Change Evaluation (FORCE) to assess the characteristics of readiness for change across two programs (N=216 employees) in an interprofessional rehabilitation hospital that was about to undergo strategic changes as part of a planned physical merger within the next two years. The study used a mixed-method approach: a quantitative survey, previously validated in a drug rehabilitation setting, followed by key informant interviews to further enlighten survey findings. Statistical analyses identified correlations between demographic variables (age, education and experience) and readiness for change, as well as the prevalence of specific organizational characteristics (motivation for change, access to resources, staff attributes, organizational climate, and exposure/use of training opportunities) that facilitate or impede change. Findings were intended to better inform the tactics for successful implementation of upcoming initiatives. Much like assessing a patient prior to initiating a treatment, FORCE can serve as a management tool to direct the planning and implementation of changes intended to improve hospital performance. http://www.longwoods.com/product.php?productid=18418&cat=450 7FFA1124-FF52-45B8-A249-9BFE2CE586C3 Fri, 15 Sep 2006 14:10:40 -0400 This paper suggests that we have underestimated the importance of people management in improving practice within hospitals, with the three most important aspects being the development of teamwork, performance management and sophisticated training. We present evidence of the potential contribution good people management can make to high performance, and argue that better people management is a cause, not an outcome, of cultural change. http://www.longwoods.com/product.php?productid=17096&cat=357 5F8CD3E5-3815-486F-AB8B-16A7902034DC Tue, 15 Mar 2005 14:09:45 -0400 The past decade has witnessed so many social, technological and economic alterations, renovations and revolutions that a new norm has emerged in healthcare. This new norm is constant and unrelenting change. Further change will likely be the reality in the next decade, also. Consider that the "baby boomers," by the year 2020, will be the "new" elderly. Lifespan will continue to increase. The growth and development of non-North American economies will increasingly challenge our own. Techno-logical and radical biological scientific discoveries will be part of the new norm. While many decry the pace and complexity of change, this commentary suggests, perhaps ironically, that even more change should take place, specifically in the nursing profession. http://www.longwoods.com/product.php?productid=16258&cat=275 F6CB4C42-DF17-4F50-9E1B-584E67E0670B Mon, 15 Dec 2003 14:09:21 -0400 This paper describes and examines a change program for nursing services in Complex Continuing/Long Term Care (CC/LTC) at the Baycrest Centre for Geriatric Care in Toronto. It presents a brief history of the rise of CC/LTC services and the difficulties associated with them. In particular it claims that demographic, professional and institutional changes have produced a differentiated specialization of supports which tend to disregard some necessary aspects of daily support for patients, and devalue the role of direct care workers in these settings. The "Reconnecting to Care" (RTC) initiative is a response the to these changes by nurses at Baycrest. In detailing why Baycrest has decided to get back to basics and reconnect to care and how it has begun to do this, this paper provides an overview of the reasons for this initiative, a little of how it has been implemented so far, and some initial lessons for nursing leaders and others. http://www.longwoods.com/product.php?productid=18901&cat=490 7786A05F-A495-4BD5-B35B-B79621AC6260 Tue, 15 May 2007 14:08:45 -0400 There are at least three reasons why distilling the messages from research is becoming a specialized role. First, there has been an enormous growth in the research enterprise and the resulting publications. This makes it impossible for fellow researchers, never mind those working in healthcare, to keep up with what is going on. Second, not all research is created equal, and it requires some skill to sort the wheat from the chaff before making the "summary loaf" from the best ingredients. Third, there are many spin doctors of research in whose interests it is to do partial summaries that favour their own product or ideology. These can only be countered by those who seek out all the relevant research, favourable or not, and aggregate it into an impartial summary. This approach provides a powerful tool for healthcare managers and policy makers who are searching for ways to improve the system but unsure of where to get or how to assess the deluge of research available. http://www.longwoods.com/product.php?productid=18918&cat=492 EC7AF767-FCEB-449B-AB93-0AB023F21878 Tue, 15 May 2007 14:08:10 -0400 Issues affecting health workplaces range from serious concerns that could affect the immediate physical safety of workers to those that would improve productivity and efficiency, or make an organization a preferred employer. Employers and workers might consider effective teamwork an asset, but for patients it is a prerequisite. This paper reviews the evidence for effective teamwork, primarily that gathered by a research team funded by the Canadian Health Services Research Foundation (CHSRF). We also review the expert opinion provided by a group of 25 researchers and decision makers convened by CHSRF in late 2005 at a forum for discussion about issues related to effective teamwork. Included in the retreat were representatives from professional organizations and occupations as well as areas such as legal liability. http://www.longwoods.com/product.php?productid=18669&cat=467 AE2D008E-1F70-481B-B916-4348A3784349 Mon, 15 Jan 2007 14:07:16 -0400 A Protocol for the Investigation of Clinical Incidents (1999) was piloted on a Winnipeg high-risk neonatal service in 2001, and was subsequently adopted as the investigative tool of choice at the Winnipeg Regional Health Authority (WRHA). The paper describes the pilot and subsequent experience with the updated London Protocol (2004) in the WRHA Child Health Program. Themes include: tightly coupled systems; multiplicity of contributory factors; medication safety; predominance of "near misses"; authority gradient; professional accountability; partnerships; and implementation challenges. The London Protocol is an invaluable tool for review of critical occurrences and near misses. To maximize impact on patient safety, healthcare organizations must involve partners and develop expertise in human factors and change management. http://www.longwoods.com/product.php?productid=18449&cat=452 B294AAD8-003C-4703-B8DC-228750B2360B Sun, 15 Oct 2006 14:03:44 -0400 The implementation of a Medication Order Entry/Medication Administrative Record (MOE/MAR) system inevitably involves substantial technological and change-process challenges. No system can meet the needs of all potential user groups, nor can any hospital's information technology (IT) budget for a MOE/MAR-type initiative be unlimited. This paper describes the process by which the University Health Network's (UHN) IT department, called Shared Information Management Services (SIMS), in implementing this new system attempted to take advantage of recent technological advances, satisfy users and do so within budget constraints. The challenges of doing so in this large, academic hospital organization are identified, drawing on both our successful and less successful design and implementation efforts. http://www.longwoods.com/product.php?productid=18502&cat=457 322656AB-861E-410D-9C20-3D3A27572050 Wed, 15 Nov 2006 14:03:04 -0400 This article is the first in a series of articles examining Ontario's Wait Time Strategy. The series begins with the Strategy's key elements, assesses progress made after one year, and identifies the lessons learned thus far. http://www.longwoods.com/product.php?productid=18101 EA59FFAC-D49D-490C-993E-CB3763BC1A1E Wed, 15 Mar 2006 14:02:27 -0400 The current issue of the Longwoods journal, HealthcarePapers (Vol. 2 No. 1) examines strategies for improving the safety of patients in the healthcare system. The lead paper was written by two Canadian experts, G. Ross Baker at the University of Toronto and Peter Norton at the University of Calgary, who are to be commended for putting the issue forward. In this issue of Hospital Quarterly we are pleased to publish the abstract of their paper. We are fortunate to have a comprehensive response from Australian Ross Wilson who led The Quality in Australian Health Care Study and is considered a world authority on patient safety. http://www.longwoods.com/product.php?productid=16781 5B4FCA12-A69C-4F63-B635-BC4BEFAABBFE Thu, 15 Mar 2001 14:01:50 -0400 Ontario's Wait Time Strategy - a significant change management initiative - is designed to improve access to healthcare services in the public system by reducing the time that adult Ontarians wait for services in five areas by December 2006 (cancer surgery, cardiac revascularization procedures, cataract surgery, hip and knee total joint replacements, and MRI and CT scans). These five are just the beginning of an ongoing process to improve access to, and reduce wait times for, a broad range of healthcare services beyond 2006. http://www.longwoods.com/product.php?productid=18311 AFDEBAE3-F86E-4EE1-8567-4CEC37739AAF Sat, 15 Jul 2006 14:01:14 -0400 Increasingly, outsourcing is becoming a watchword for many organizations in many disciplines, both in the private and the public sector. In 2003, the global outsourcing market was estimated to be US$353 billion, and in 2004 it is expected to be US$406 billion (Caldwell and Cantara 2002). Like private sector organizations, hospitals are increasingly outsourcing services from food/cafeteria and security and facilities maintenance to the consulting and training of personnel1 and information technology (IT) functions. Also like private sector organizations, while hospitals seek the cure that will improve services at less cost, without careful management the cure can be worse than the disease. This could leave the hospital struggling with two unpalatable choices: either living with an underperforming service provider and/or skyrocketing costs until the outsourcing arrangement limps to the end of its term, or terminating the arrangement and incurring the resulting delays/failures in the services and potentially serious financial penalty payments to the outsourcing vendor.. This article is intended to guide hospitals engaged in outsourcing on how best to manage each stage in the transaction to ensure that the outsourcing successfully achieves the objectives of the hospital. http://www.longwoods.com/product.php?productid=16621&cat=329 78377892-5854-4D6A-8389-14E94182C1F5 Mon, 15 Mar 2004 14:00:29 -0400 Despite numerous publications outlining the magnitude of patient safety issues, the literature provides limited strategies for organizations to develop comprehensive, effective patient safety programs. Hamilton Health Sciences (HHS) has created a framework to foster local accountability called Patient Safety Triads and Networks. The Networks operationalize patient safety initiatives, develop knowledge and improve patient safety culture in a collaborative interdisciplinary team model. They have proven to be an effective way to support patient safety at the local level and to integrate organizational and local work on patient safety. http://www.longwoods.com/product.php?productid=18462&cat=452 60DAE0C8-FAEB-4F77-810F-52185CE41C9B Mon, 15 Oct 2007 13:59:45 -0400 This paper describes the critical success factors in the design and implementation of CCO's CPOE system, including Web-based training and ease of administration to maximize physician adoption, incorporating point-of-care access to clinical practice guidelines into the tool, and the use of CPOE data to monitor and increase access to anti-cancer drugs and patient safety. http://www.longwoods.com/product.php?productid=18468 536F1812-2B4E-49EB-9896-624BDE70BCF9 Sun, 15 Oct 2006 13:58:58 -0400 Currently, there is no standardized approach in practice for collecting and organizing data and information on health outcomes for most of our healthcare disciplines including nursing, pharmacy, occupational therapy and physiotherapy. For many years, nurse administrators have experienced frustration over the lack of significant data regarding nurses' work that has a direct impact on patient outcomes. This situation has been particularly problematic when justifying budgets or publicly demonstrating how nurses directly affect the health of their patients and clients. At the same time, given the range of personnel who deliver direct care to patients, collecting data related to patient outcomes would allow administrators to guide their allocation of care to other regulated and non-regulated healthcare workers. This significant shift in the use of patient outcomes in the practice setting needs to be integrated into nursing education curricula so that students will be prepared conceptually, technically and practically for the changes that are currently happening. http://www.longwoods.com/product.php?productid=18365&cat=451 AB168FB7-F757-442F-908E-EE4EC8E3C6F2 Fri, 15 Sep 2006 13:57:58 -0400 The authors of the lead essay present a compelling case for the development and implementation of a national strategy on chronic disease prevention and management (CDPM). The literature demonstrates that the Chronic Care Model can improve quality and reduce costs. Substantial evidence supports the role of health information technologies such as electronic health records (EHRs) in achieving these goals. http://www.longwoods.com/product.php?productid=18997&cat=495 3FB0EF23-161A-44E3-B09E-CB7A702F1A9F Fri, 15 Jun 2007 13:57:21 -0400 The Ontario Wait Time Strategy is a focused initiative to reduce wait times in five key areas. The plan includes key components of successful change management including targets, funding and driving a culture of accountability. Successfully "redesigning" this slice of the healthcare system will, it is anticipated, act as a catalyst for sustainable change throughout the system. In the mind of this observer "from the trenches," the Wait Time Strategy must quickly be followed by a framework that addresses demand pressures from other parts of the system, but more importantly must be clearly aligned with the overall goals of the system - to improve health outcomes and support healthy lives - across the entire continuum of health services, including prevention, primary, community, long-term and acute care. Accountability for appropriateness and evidence-based care must be as significant as accountability for efficiency and volumes. http://www.longwoods.com/product.php?productid=18315&cat=448 145D3760-56B6-4949-A138-1C8D8B0D8F97 Sat, 15 Jul 2006 13:56:23 -0400 This issue of Healthcare Papers provides a succinct analysis of Ontario's Wait Time Strategy, which was initiated in November 2004 - less than two years ago - by senior leaders in the Ontario Ministry of Health and Long-Term Care. In the article, Joann Trypuc, Hugh MacLeod and Alan Hudson describe their recent actions to implement the changes and examine strategies to develop a culture to sustain Ontario's Wait Time Strategy over time. The paper begins with an overview of the Strategy followed by a discussion of the accountabilities of a wide range of individuals and groups. These include hospital boards and management, the public, healthcare providers, government and Local Health Integration Networks. The authors conclude by identifying three major tools that can help support a culture to sustain the Strategy over the next decade. http://www.longwoods.com/product.php?productid=18621 94156D66-491E-498D-B996-4498ED6041BF Mon, 15 Jan 2007 13:55:38 -0400 After 10 years and two successful terms, a Chief of Diagnostic Imaging informs the Chair, Medical Advisory Committee (MAC), that, in accordance with a mandatory two-term maximum tenure, he will be stepping down as Chief six months hence. Not of retirement age, he plans to remain on the active hospital staff and be an active participant within their off-site partnership. He agrees to stay on as Chief until his successor is on site as per the bylaws. http://www.longwoods.com/product.php?productid=16656&cat=324 B86442BE-1C56-4452-AFEF-66D4466C6160 Sun, 15 Dec 2002 13:54:53 -0400 Quality councils are an increasingly common phenomenon in Canada. The Health Quality Council in Saskatchewan, the largest such council in Canada, is similar to other councils in that it reports publicly on quality of care, but it differs in that it has an explicit, central role to support quality improvement activities. The HQC strives to gain buy-in and cooperation from provider groups, even those identified as having suboptimal care, by offering them quality improvement training, measurement tools, information about best practices and advice from experts in change management, group psychology, process redesign and operations research. Developing relationships with stakeholders is a very labour- intensive process, but it is essential to fostering a blame-free culture of quality improvement. The HQC works with senior leaders to help coordinate province-wide priorities for quality improvement and with middle managers and frontline staff to establish local quality improvement teams. It does not alter the structure of existing accountability relationships; rather, it tries to make the dialogue more quality-focused. Its largest-scale activity is a Learning Collaborative involving 20% of all family physicians in the province in an effort to improve chronic disease management. The HQC believes that these targeted, coordinated activities in quality improvement will ultimately be far more effective than simply releasing reports or making recommendations. http://www.longwoods.com/product.php?productid=18062&cat=432 4019BD62-B183-46F1-8053-A6BCBD96D095 Wed, 15 Mar 2006 13:53:55 -0400 In this issue of ElectronicHealthcare, we feature several articles that address the challenge of motivating physicians to adopt electronic record systems. I chose the humorous anecdote above to highlight the difficulties inherent in introducing a major change in clinical practice. Financial considerations and issues relating to the professional independence of clinical professionals are certainly key factors to be addressed as part of any change-management strategy. But, as the articles in this issue highlight, there are a multitude of other factors that have to be managed to achieve widespread physician adoption of these systems. http://www.longwoods.com/product.php?productid=16155&cat=262&page=1 7031603A-15CD-4789-BE01-AB31BCCDD75C Fri, 15 Aug 2003 13:53:22 -0400 Re-engineering projects, e-health initiatives, mergers and cultural change agendas often fail. A 2002 article that integrated the results of 49 studies on major change projects found that complex initiatives fail 67-81% of the time (Smith 2002). A typical reaction to these statistics is to increase the level and rigour of project management efforts. In contrast, Starfield Consulting's recent study found that successful leaders emphasized an effective change strategy far more often than project management. This has implications for change leaders who are hiring project managers or establishing project management offices. http://www.longwoods.com/product.php?productid=18812&cat=481 8AF906D0-D48D-44B7-932A-D685ACE1B76A Sun, 15 Apr 2007 13:51:59 -0400 The preceding papers in this issue of Healthcare Quarterly provide a "how-to" guide to mounting a complex, across-the-organization change, and also reveal the unique perspectives of the different professional groups involved in the change. In addition, the paper "Executive Perspective: The Business Case for Patient Safety" (see p. 20 in this issue) reveals how the University Health Network's (UHN) Executive Team came to the decision to pursue the specific Medication Order Entry/Medication Administration Record (MOE/MAR) initiative. Each paper in this issue of HQ ended with "Lessons Learned" unique to each UHN leader's perspective. In contrast, this paper looks back on the five-year initiative, from all perspectives, in order to provide a final set of observations for organizations considering the implementation of a MOE/MAR-type project. More generally, this paper speaks to healthcare leaders who are contemplating significant changes in their organizations. http://www.longwoods.com/product.php?productid=18507&cat=457 8A5BB624-1B7E-4CF8-ADF3-29D7436D036C Wed, 15 Nov 2006 13:50:58 -0400 This article reports on the results of UHN's multi-year study looking at the impact of MOE/MAR. In our overview, we examine such elements as the methodology used as well as the challenges and constraints faced by the team. We also examine the following: the types of lessons learned during MOE/MAR's implementation; the effectiveness of teamwork; and the impact of external resources upon the project. http://www.longwoods.com/product.php?productid=18505&cat=457 635F77E2-3BC7-455E-8C14-8034CE9D07F6 Wed, 15 Nov 2006 13:50:30 -0400 The implementation of a computerized physician order entry (CPOE) and medication administration system may seem at first glance to be primarily an information technology (IT) challenge. Yet those institutions that have implemented these applications have discovered that success is often more dependent upon behavioural changes in the medical staff. The fact is, putting the world's most advanced technology at a physician's fingertips does not provide any guarantee that he or she will not simply bypass the system by scribbling out a prescription. http://www.longwoods.com/product.php?productid=18504&cat=457&page=2 E5978E5F-9C42-4267-9DCA-57FF44FCB728 Wed, 15 Nov 2006 13:49:57 -0400 The implementation of a Medication Order Entry/Medication Administrative Record (MOE/MAR) system inevitably involves substantial technological and change-process challenges. No system can meet the needs of all potential user groups, nor can any hospital's information technology (IT) budget for a MOE/MAR-type initiative be unlimited. This paper describes the process by which the University Health Network's (UHN) IT department, called Shared Information Management Services (SIMS), in implementing this new system attempted to take advantage of recent technological advances, satisfy users and do so within budget constraints. The challenges of doing so in this large, academic hospital organization are identified, drawing on both our successful and less successful design and implementation efforts. http://www.longwoods.com/product.php?productid=18502&cat=457 29098ED7-9398-451F-B397-90BEB4F36C7F Wed, 15 Nov 2006 13:49:27 -0400 For UHN, it was clear from the beginning that the MOE/MAR implementation would only be successful if there were widespread acceptance of medication order entry by front-line clinical staff. Otherwise, this bold initiative would end in abject failure. Fundamental to the project's success was acceptance of MOE/MAR by UHN's physicians. Many physicians questioned whether MOE/MAR would impede their ability to care for their patients. At this stage, there was still uncertainty whether CPOE (Computerized Physician Order Entry) "did more good than harm." By constantly revising the system and by recruiting some key individuals that would act as MOE/MAR "champions" and advisors, resistance to the project decreased. The following article examines the implementation of MOE/MAR from the physicians' perspective. http://www.longwoods.com/product.php?productid=18499&cat=457&page=1 09DCB06E-8AB7-41F6-8D87-B77023DE2A3A Wed, 15 Nov 2006 13:49:07 -0400 The following article explores the MOE/MAR-driven changes from the perspective of nurses. The examination of the collaboration and coordination of the Nursing Informatics (NI) Team with Nursing, the role of Nursing Informatics, the collaboration with the Project Team from Shared Information Management Services (SIMS), the Education Working Group and the Computer User Support Program (CUSP) are features of this journey into the electronic world during the implementation of MOE/MAR. http://www.longwoods.com/product.php?productid=18497&cat=457 A50B6C3B-34F4-4EF2-BA20-FA982BA26134 Wed, 15 Nov 2006 13:48:23 -0400 The successful implementation of the University Health Network's (UHN) Medication Order Entry/Medication Administration Record (MOE/MAR) project was dependent on the Pharmacy department working collaboratively with many other stakeholders in the organization. This paper highlights the Pharmacy department's contribution to MOE/MAR by assessing four main areas: (1) the Pharmacy department's role in developing the technical MOE/MAR solution; (2) Pharmacy department staffing challenges; (3) workflow changes and "workarounds"; and (4) clinical practice changes to support the implementation. While some of the patient safety benefits from MOE/MAR will be alluded to in this paper, more detailed analysis of MOE/MAR benefits are found in "The Benefits of the MOE/MAR Implementation: A Quantitative Approach" (see p. 77 in this issue). http://www.longwoods.com/product.php?productid=18496&cat=457 BA443E1F-D427-49DB-9B85-3D415155D7BF Wed, 15 Nov 2006 13:47:54 -0400 As anyone with the slightest connection to the healthcare sector knows, hospitals are unique environments. They are the cornerstones of our communities and they provide for the well-being of our citizens. Physically, they are complicated places, with buildings, people and a vast amount of sophisticated equipment. Publicly, they are under constant scrutiny and pressure to become more patient-centred. Financially, they face a near-constant state of having to do more with less. Understandably then, the technology requirements of hospitals are unlike those encountered in any other sector. For quite some time, the ideal hospital was envisioned to be unified, well-equipped technologically and multi-functional; however, for a variety of reasons - not the least of which is budgetary restraint - hospital IT environments have featured piecemeal implementations, which might satisfy financial management concerns, but do little to increase patient comfort and care or meet increasingly sophisticated departmental needs. After many false starts, stretching back at least two decades, where the existing technologies - both hardware and software - simply could not deliver on the promise of complete integration, greater efficiency, at less cost, the Digital Hospital is now finally a reality. http://www.longwoods.com/product.php?productid=18495&cat=457 FE1F7F08-79BD-4E38-A083-FB53B175BB3D Wed, 15 Nov 2006 13:46:58 -0400 When Toronto-based University Health Network (UHN) initiated its Medication Order Entry/Medication Administration Record project (MOE/MAR) in 2001, it was well understood by the organization that this would be one of the largest change management initiatives undertaken. Being the largest academic hospital in Ontario and the eighth largest healthcare organization in Canada, a successfully implemented computerized physician order entry (CPOE) project in this complex environment would require rigorous project management, significant clinical involvement and a well-developed change management program. The extensive project management approach employed by UHN to support the MOE/MAR implementation will be discussed in this paper. The major phases of the MOE/MAR project are described from the perspective of the project team to highlight key activities undertaken, decisions made and challenges faced. Next, an analysis of the project management process is provided along with reflections of the approach taken and challenges encountered. Consistent with UHN's methodology to incorporate knowledge gained from the early phases of the MOE/MAR project into future implementations, we hope to provide insight to other organizations considering CPOE initiatives. http://www.longwoods.com/product.php?productid=18493&cat=457 91F640D5-D128-4011-987C-4B275ED1155A Wed, 15 Nov 2006 13:46:30 -0400 Conventional wisdom dictates that hospitals are institutions in which ailing or injured people go for a temporary visit, their discharge ultimately dependent upon either a partial or complete recovery. Unfortunately, the most well-intended acts sometimes result in tragedy. Depending upon the severity of a patient's condition, sometimes a visit to the hospital is a one-way excursion. And in some cases (most would argue in too many cases), the reason a patient dies within the confines of a hospital is due to the lack of a systems approach to patient safety. http://www.longwoods.com/product.php?productid=18491&cat=457 7FEE8B66-2E69-44CA-8312-3837788478B3 Wed, 15 Nov 2006 13:45:46 -0400 Imagine you are a member of a hospital's executive team, having just left a meeting in which you and other members discussed the possible introduction of an ambitious Computerized Physician Order Entry (CPOE) system. Around the conference table you and others questioned whether CPOE would be the most effective way to realize your hospital's commitment to patient safety. Other issues that were raised included whether clinicians would support or resist the change, whether staff would have sufficient skills, where to begin, affordability and whether to proceed incrementally or with a "big bang." While there was much disagreement with respect to each of the issues, there was near unanimity around two important decisions - CPOE would be implemented and you would be the executive responsible for the system's design and implementation. This article, based on the experiences of a multi-site hospital, and drawing on past research on organizational change, provides a Four-Stage model to help change leaders in healthcare. Although relying on Toronto's University Health Network to illustrate the change model, the model is intended to speak to change leaders implementing various types of complex changes in all healthcare organizations. http://www.longwoods.com/product.php?productid=18490&cat=457 AEED5B7D-C3F3-4147-92ED-04F35C0C6A63 Wed, 15 Nov 2006 13:43:16 -0400 Advanced practice nursing in Canada is receiving attention locally and nationally as gaps in our healthcare system persist, specifically as they relate to access to care and wait times. Nationally, nurse practitioners (NPs) and nursing leaders have developed documents that begin to define the foundation required for the successful introduction, evolution, evaluation and sustainability of the NP role (Bryant-Lukosius and DiCenso 2004). Much work has been done to promote the role of the nurse practitioner across Canada as provinces and territories learn from one another and overcome barriers to furthering this advanced practice nursing role (CNA 2006). http://www.longwoods.com/product.php?productid=18900 E0C9CAA8-9932-4265-8C5E-899E38F23428 Tue, 15 May 2007 13:42:31 -0400 When Toronto-based University Health Network (UHN) initiated its Medication Order Entry/Medication Administration Record project (MOE/MAR) in 2001, it was well understood by the organization that this would be one of the largest change management initiatives undertaken. Being the largest academic hospital in Ontario and the eighth largest healthcare organization in Canada, a successfully implemented computerized physician order entry (CPOE) project in this complex environment would require rigorous project management, significant clinical involvement and a well-developed change management program. http://www.longwoods.com/product.php?productid=18493&cat=457 F4F3A4DA-6CA4-4DAD-B5B1-2770D097FB39 Wed, 15 Nov 2006 10:43:05 -0400